Feet > Midfoot Sprain

What is a Midfoot Sprain?

A midfoot sprain is a common type of foot sprain that affects ligaments in the middle of your foot. Ligaments attach your five, long metatarsal bones to four smaller bones (three cuneiform bones and the cuboid) at five tarsometatarsal joints. The combination of all five tarsometatarsal joints is called the midfoot joint. The cornerstone that stabilizes your midfoot joint is the second tarsometatarsal joint, which is stabilized by Lisfranc’s ligament. This ligament connects your second metatarsal bone, at the base of your second toe, to the medial cuneiform bone, which is on the inside of your foot. It is common to sprain or tear the Lisfranc’s ligament during sports and activities. Lisfranc’s ligament also can avulse, meaning it can pull a piece of bone off the bones in the middle of your foot. Basically, when your Lisfranc’s ligament is torn or sprained, the bones in the middle of your foot can fracture and dislocate. The sprain usually starts as a subtle injury that can worsen as the base of your second metatarsal becomes unstable because of the sprained ligament. When you suffer a Lisfranc’s fracture in your second metatarsal, the adjacent bones in your midfoot, connected to your three smaller toes, also can become unstable and dislocate.av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Midfoot sprains and fractures are most commonly caused by a large amount of force applied through the center of your foot. Contact sports like football commonly cause midfoot sprains when your heel is lifted off the ground and someone falls on your foot. The three most common causes of midfoot sprains and fractures in athletes are as follows:

   Compression – When a force compresses your toes and heel together, the middle of your foot may not be able to withstand the strain.

   Foot entrapment – Falling backward when your foot is fixed in a position, such as falling down stairs or out of a saddle with your foot trapped in a stirrup, can fracture your midfoot.

   Falling directly on your toes – When your foot is pointed straight down, which commonly occurs during ballet dancing, and your fall directly on your toes, your midfoot may absorb too much weight.

av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Considerations

If left untreated, even a small amount of displacement in your second metatarsal joint can cause a lot of pain and eventually lead to a collapse of your arch. Untreated midfoot sprains usually become disabling injuries. Opinions about treating midfoot sprains vary. Some physicians may prescribe surgery earlier than others. If your midfoot bones have shifted out of their normal position, the bones may need to be put back into place, a process called reduction. Your midfoot joint may need to be held in the proper position while your bones and ligaments heal. Your physician may be able immobilize your foot in a cast to heal a minor Lisfranc’s ligament sprain or tear. Depending on the damage to your bones and soft tissues, surgery may be the best option to fix your midfoot bones in position.av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.

Orthopedic Evaluation

There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

MEDICAL HISTORY

Your physician likely will ask about your activities, which may have caused you to sprain your midfoot. You will probably be asked when the soreness or pain began. If you have had any prior foot injuries, your physician will ask about treatments you may have tried in the past. Physicians also typically ask about other conditions, such as diabetes and allergies, and medications currently being taken. You may also be asked about your physical and athletic goals – information that will help your physician decide what treatment might be best for you in achieving those goals.

Physicians often can diagnose midfoot sprains by putting direct pressure on the middle of your foot, as it usually is tender on the top and bottom when pressure is applied. In a typical diagnosis, your ankle is held steady and your toes are rotated side-to-side. If you have fractured your midfoot, this test can cause a lot of pain. However, as a comparison, this test is not as painful as having your ankle rotated to check for a sprained ankle.

TESTS

X-rays taken from different angles usually can show fractures in your midfoot. If soft tissues in your foot interfere with the X-ray images, your physician may order CT scans to get a clearer picture of your bones.av=PAT&doc_id=29" target="_new">William G. Hamilton, M.D., team physician for the New York Knicks and New Jersey Nets.